This information is especially for patients who will undergo surgery.

Adrenalectomy

What to Expect and How to Prepare for Your Operation

This operation is performed to remove an adrenal tumor. Your doctor can perform this operation two ways.

Laparoscopic: four small incisions are made in the abdomen. The abdomen is filled with CO2 gas to lift the skin off of the organs and allow the doctor to see better. By using a special scope and instruments the operation can be performed. The benefit of this method are smaller scars, and a quicker recovery.

Open: An incision is made across your side, underneath your ribs. The doctor then will do the operation through the incision.

Your doctor will discuss which operation technique is the best for you.
This pamphlet outlines what to expect, how to prepare for your operation, and plan for your recovery.

Remember:
No Aspirin

How to Prepare for Your Operation

Things to Remember

Do NOT take any aspirin or aspirin-like products for one week before your operation (see attached sheet for more information).
If your adrenal tumor is of a certain type your doctor may require that you have an evaluation of your heart before your operation.
You will stay in the hospital for 3-5 days after your operation. When you go home, you may need help with food preparation and general support for 1-2 weeks.
To prevent pneumonia after your operation the clinic nurse will teach you coughing and deep breathing exercises.

24 Hours Before Your Operation

Things to Do

Bowel Preparation - You may need a bowel prep to prepare for your operation. Your nurse will give you written instructions to follow.
Shower - Using the antibacterial soap your nurse gave you, shower and soap your body. Do not use the antibacterial soap on your face and hair. (See directions attached to the soap bottle.) Use your own soap and shampoo on your face and hair. Use clean towels to dry off, and put on clean clothing.
Arrival Time - The pre-surgery nurse will call you by 5:00 p.m. the night before your operation. If you are having surgery on Monday, the nurse will call you on Friday. If you do not hear from the nurse by 5:00 p.m., please call 206-598-6334.
The pre-surgery nurse will tell you when to come to the hospital and remind you to:
- not eat or drink after a certain time
- take or not take your regular medications
- take high blood pressure, thyroid and seizure medications the day of surgery. Use only enough water to swallow your pills.

What to Expect After Your Surgery

Waking Up After Your Operation
You will wake up in the recovery room. You will feel sleepy. You will have:

An IV in your arm which will be used to give you medicine for pain and nausea.
An epidural catheter may be in your back to give you pain medicine. (Your anesthesiologist will discuss the benefits of this.)
A catheter tube may be inserted into your bladder to drain your urine.
Sequential Compression Devices (SCD's) which are inflatable stockings for your legs.

Nutrition
The day of your surgery you will not be allowed to eat anything by mouth. You will receive fluids through your IV to keep you from getting dehydrated. As your intestines recover from your operation you will pass gas. When this happens you will be able to take clear liquids by mouth. As you tolerate that without having nausea your diet will be advanced to a regular diet as soon as your doctor orders it.

Activity
Every day you will increase the amount of activity that you do. This is very important to prevent pneumonia from developing in your lungs and blood clots from forming in your legs. The day of your operation your nurse will help you sit on the edge of the bed. The first day after your operation you will sit in the chair three times during the day and begin to walk. Two days after your operation you will walk in the hall three times. As your strength returns you will be encouraged to do more.

Bowels
After your operation it will take a few days for you to have your first bowel movement. Avoid constipation. Please refer to the information sheet "Constipation After Your Operation."

Recovery

Recovering in Your Hospital Room

Incision
You will have one of the incisions described on the front of this pamphlet.

If you have a laparoscopic operation your four or more small incisions will be covered with white tapes called steri-strips. Your skin will have stitches that absorb over time and do not need to be removed.
If you have the open repair with an incision across your side, your skin will be closed with surgical clips. These will be removed at your first office visit after your operation.

Pain Management
You will probably have a pain medicine pump for 1-4 days after your operation, which you control. This will allow you to get medicine when you need it so that you are comfortable. The anesthesiologist may discuss with you the opportunity to have an epidural catheter to control pain after your operation.

You will need someone to pick you up from the hospital and you may appreciate help at home for the first week
or longer.

When you go home, use the pain medicine your doctor prescribed for you.

Precautions and Self-Care to Speed Your Recovery

Shower
You may shower daily.

Incision
When you go home you will be instructed to look at your incision every day. Notify your doctor if you have any of the signs of infection listed on the last page of this pamphlet. As you heal you will have a thick healing ridge develop at the site of your incision. This will soften and flatten out over several months.

Questions?

Contact Surgical Specialties Nurse Advice Line:
206-598-4549
Monday - Friday
8:00 a.m. - 4:00 p.m.
After hours call Paging:
206-598-6190
and ask them to page the resident on call for General Surgery, or Dr.__________ your attending surgeon.

Call the Nurse Advice Line or Your Doctor If:

You have bleeding or drainage that soaks your dressing.
Your temperature is greater than 100.5°F or 38.5°C, or you have shaking.
You have any sign of infection: redness, increased pain, swelling, foul smelling drainage, or increase in the amount of drainage from your wound.
You have recurrent or persistent nausea and/or vomiting.
You have concerns that cannot wait until your follow-up appointment.

First Follow-up Visit
At your first office visit your nurse and doctor will review with you how you are doing at home. It is important to know how your appetite is, and how your bowels are working. Your surgical incision will be examined, and any surgical clips will be removed. Your doctor will review your pathology with you. At this time they will ask how your pain is and what medication you are taking. They will also ask you what your activity level is and when you plan to return to work.

Activity

To help speed your recovery you should walk daily. You should also gradually increase the distance that you walk. If you have a:

Laparoscopic procedure, —do not lift anything heavier than 15 pounds for one week.
Open procedure—do not lift anything heavier than 15 pounds for three weeks from the time of your operation.
Activities like gardening, vacuuming, and aerobic activities should be avoided during your recovery.
Sexual activity: With either surgery method it is okay to resume sexual activity when you feel ready. In general, activities that do not hurt are safe.

Return to Work
How much work you take off depends on what you do for a living. Most people take two weeks to a month off to recover. As you feel able you may return to work. Some patients choose to start off with shorter days and then increase their hours as their energy allows.

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